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INTRODUCTION

TO

FIRST AID

DR.P.RAMESH BABU                                                                                                     M.B: B.S: A.F.I.H.                                                                       MEDICAL SUPERINTENDENT

Learning first Aid is a civic responsibility of each citizen

FIRST AID Is the initial assistance or treatment given to a casualty for any injury or sudden illness before the arrival of an ambulance, Doctor, or other qualified person? FIRST AIDER: Is usually applied to some one who has completed a course of theoretical and practical instruction, and passed a professionally supervised examination. FIRST AID QUALIFICATIONS: The standard First Aid Certificate, awarded by 1.	St. John Ambulance, 2.	St. Andrew’s Ambulance Association, 3.	British Red Cross 	Is proof of all round competence. 	It is valid for three years. 	To keep your knowledge and skills up to date, you must be re-examined after further training. 	First Aiders may volunteer for additional training to broaden the scope of their skills.

THE AIMS OF FIRST AID 1.	To preserve life. 2.	To limit the effects of the condition. 3.	To promote recovery.

THE FIRST AIDER IS 1.	Highly trained. 2.	Examined & regularly re-examined. 3.	Up to date in knowledge &skill

RESPONSIBILTIES OF FIRST AIDER 1.	To assess a situation quickly and safely, and summon appropriate help. 2.	To identify, as far as possible, the injury or the nature of the illness affecting a casualty. 3.	To give early, appropriate,& adequate treatment in a sensible order of priority. 4.	To arrange for the removal of the casualty to a hospital, to the care of a Doctor, or home. 5.	To remain with a casualty until handling him or her to the care of an appropriate person. 6.	To make & pass on a report and give further help if required. RULES OF FIRST AID Best advice to first aider is “Make Haste Slowly” 1. Reach the accident spot quickly. help to save life 2. Be calm, methodical and quick. 3. Look for the following., a) Airway             b) Bleeding c) Circulation 4. Use the First Aid equipment. 5. Inspect the area 6. Clear the crowd with nice words. 7. Note the weather. 8. Reassure the casualty 9. Arranger to dispatch to the care of a doctor or to the hospital. At         the same time intimate to the relatives where the casualty is       shifted. 10. Do not attempt too much: You are only a first aider and give minimum assistance so that the condition does not become worse: & life can be saved.

FIRST AID AT WORK

The Health& Safety at Work Act of 1974 requires employers to ensure, as far as is reasonably practicable, the Health, Safety, & welfare of employees at work. T        These duties are defined & controlled by the Health & Safety Executive. The Health & Safety (First Aid) Regulations (1981) place a general duty on employers to make First Aid provision for employees in case of injury or illness at work. The practical aspects of this statutory duty are set out in the approved code of practice and guidance notes, 1990 revision (HMSO). Regular occupational First Aiders should be familiar with the notes, which define: 	Minimum standards for First Aid provision, including numbers of First Aiders and the requirement for First Aid rooms. 	The content of First Aid kits. 	The definition of “suitable persons” to practice FIRST AID. 	Recruitment, Training, & examination. 	Arrangement to cope with specific hazards. 	Standards for the keeping of records of First Aid plasticized in the workplace.

RECORDING FIRST AID ADMINISTERED AT WORK: You should note the following details: 	Full name & address of the casualty. 	The casualty’s occupation. 	Date when entry made. 	Date & Time of Accident. 	Place & circumstances of accident (describe the work process being performed at the time). 	Details of injury & treatment given. 	Signature of person making the entry.

FIRST AID AT MASS GATHERINGS: The minimum requirements laid out by the Taylor recommendations are: 	One trained First Aider per 1,000 spectators. 	One approved designated first aid room. 	One trained “crowd” doctor at any event with more than 2,000 spectators. 	One ambulance authority approved fully equipped ambulance at any event with an expected crowd of 5,000. The responsibility for control of these standards will be that of the local licensing authority, where appropriate. BEING A FIRST AIDER 	Doing your best. 	Weighing up the risks. 	Being criticized. GIVING CARE WITH CONFIDENCE: Every casualty needs to feel secure in safe hands. You can create a beneficial atmosphere of confidence & assurance by: 	 Being in control, both yourself & the problem. 	 Acting calmly & logically. 	 Being gentle, but firm, with your hands, & speaking to the casualty kindly, but purposefully. 1.	Building up trust. 2.	Telling relatives. 3.	Coping with children. LOOKING AFTER YOURSELF: 	Seeking immunization. 	Coping with unpleasantness. 	Taking stock after an emergency.

ACTION AT AN EMERGENCY THE FIRST AIDER SHOULD: 1.	Assess the situation. 	Take in what has happened quickly & calmly. 	Look for dangers to yourself & to the casualty. 	Never put yourself at risk. 2.	Make the area safe 	Protect the casualty from danger. 	Do not try to do too much yourself. 3.	Assess all casualties and give emergency aid 	With more than one casualty, follow the findings of your assessments to decide treatment priorities. 	Quickly establish whether the casualty: a)	Is fully conscious. b)	Is Unconscious, but breathing. c)	Is not breathing, but has a pulse. d)	Has no Pulse. 4.	Get help 	Quickly ensure that any necessary specialist help has been summoned & is on its way. 

Control your feelings - Take a moment to think. - Do not place your self in danger. - Use your common sense. - Do not attempt too much alone. You have to do 	Maintain safety 	To telephone for help 	Start giving First Aid.

Other People can be asked to: 	Make the area safe. 	Telephone for assistance. 	Fetch first aid equipment. 	Control traffic on lookers. 	Control bleeding, or support a limb. 	Maintain the casualty’s privacy. 	Help move a casualty to safety. Give clear instructions and they are carried out. Telephone to whom: 1.	Emergency services: Fire, Police, & Ambulance Services. 2.	Public utilities: Electricity & Water. 3.	Health Services: Doctor, Nurse. Calling emergency service, you have to give the following information: 	Your telephone number. 	The exact location of incident. 	The Type & Serious ness of the Incident. 	The number, sex & approximate age of the casualties. 	Details of any hazards like Power, falling of any object. RESUSCITATION THE FIRST AIDER SHOULD: 	Keep the Brain supplied with Oxygen Following the ABC of resuscitation. 1.	Opening the Airway. 2.	Marinating Breathing. 3.	Maintaining Circulation. 	Get professional help urgently. Note: The Brain, which controls all bodily functions, must have a constant Oxygen supply. After three to four minutes’ deprivation, brain function begins to fail: consciousness will be lost, breathing & the Heartbeat will cease, & death may result. THE ABC OF RESUSCITATION A is for AIRWAY Tilting the casualty’s head back lifting the chin will “open the airway” – the tilted position lifts the casualty’s tongue from the back of the throat so that it does not block the air passages.

B for Breathing: If a casualty is not breathing, you can breathe for him or her, and thus oxygenated blood, by giving “artificial respiration” – blowing your own expelled air in to the casualty’s lungs.

C for Circulation: If the heart has stopped, “chest compressions” can be applied to force blood through the heart and around the body. They must be combined with artificial ventilation so that the blood is oxygenated.

ASSESSING THE CASUALTY’S CONDITION: DANGER                    : Are you or the casualty in any danger? RESPONSE               : Is the casualty conscious? AIRWAY                     : Is the airway open & clear? BREATHING              : Is the casualty breathing? CIRCULATION           : Is there a pulse?

ACT ON YOUR FINDINGS: STATE OF THE CASUALTY	PULSE	BREATHING	ACTION I	UNCONSCIOUS	NIL	NIL	INFORM TO AMBULANCE START & CONTINUE ARTIFICIAL RESPIRATION& CHEST COMPRESSION. II	UNCONSCIOUS	PRESENT	NIL	GIVE 10 BREATHS OFARTIFICIAL RESPIRATION& INFORM TO AMBULANCE CONTINUE ARTIFICIAL RESPIRATION III	UNCONSCIOUS	PRESENT	PRESENT	TREAT ANY LIFE THREATENING INJURY PLACE THE CASULTY IN RECOVERY POSITION GET HELP IV	CONSCIOUS	PRESENT	PRESENT	TREAT AS APPROPRIATE GET HELP IF NECESSARY.

MAKING YOUR ASSESSMENT: 	CHECK FOR CONSCIOUSNESS. What is happened? Open your eyes” Carefully shake the casualty’s shoulders. 	OPEN THE AIR WAY. Remove any obvious obstruction from the mouth. Placing two fingers under the point of casualty’s chin, lift the jaw. At the same time, place your other hand on the casualty’s forehead, and tilt the head well back. 	CHECK FOR BREATHING. Look for chest movements. Listen for sounds of breathing. Feel for breathe on your cheek. Look, listen, and feel for 5 seconds before deciding that breathing is absent. 	CHECK FOR PULSE THE RECOVERY POSITION Any unconscious person should be placed in the Recovery position. This position prevents the tongue from blocking the throat, and, because the head is slightly lower than the rest of the body, it allows liquids to drain from the mouth, reducing the risk of the casualty inhaling stomach contents. The head, neck, and, back are kept in a straight, while the bent limbs keep the body propped in a secure and comfortable position. If you must leave an unconscious casualty unattended, he or she can safely be left in the recovery position while you get help. Before turning a casualty, remove his or her spectacles, if worn, and, any bulky objects from pocket.

ARTIFICIAL VENTILATION Expired air still contains 16 percent oxygen, so you can use it to “breathe” for a casualty by blowing it in to his or her lungs. The way this is done depends on the casualty’s condition. MOUTH – TO – MOUTH VENTILATION 	With the casualty lying flat on his back, first remove any obvious obstruction, including broken or displaced dentures, from the mouth. Leave well fitting dentures in place. 	Open the airway by tilting the head and lifting the chin. 	Close the casualty’s nose by pinching it with your index finger and thumb. Take a full breath, and place your lips around his mouth, making a good seal. 	Blow in to the casualty’s mouth until you see the chest rise. Take about two seconds for full inflation. 	Remove your lips and allow the chest to fall fully. Deliver subsequent breaths in same manner. RESTORING THE CIRCULATION: Chest compressions. 1.	With the casualty lying flat on his back on a firm surface, kneel beside him, and find one of his lower ribs. Slide your fingers upwards to the point in the middle where the rib margins meet at t5he breast bone. Place your middle finger over this point (The xiphisternum) and your index finger on the breast bone (sternum) above. 2.	Place the heel of your other hand on the breast bone, and slide it down until it reaches your index finger. This is the point at which you will apply pressure. 3.	Place the heel of your first hand on top of other hand, and interlock the fingers. 4.	Leaning well over the casualty, with your arms straight, press down vertically on the breast bone to depress it approximately 4-5cm(1 half to 2 in), then release the pressure without removing your hands. 5.	Repeat the compressions, aiming for a rate approximately 80. compressions per minute. CARDIOPULMONARY RESUSCITATION: A)	When a casualty has no pulse and is not breathing, you must combine Artificial Ventilation with chest compression. B)	This is the sequence known as CPR. C)	You must, if alone call for help before you start CPR. D)	With a helper- ideally, a second First Aider- the situation becomes easier. E)	In every case, you must preserve with resuscitation attempts until either a pulse returns, professional help arrives and takes over, or physical examination forces you to stop. For one first aider: 	Dial for ambulance. 	Open the casualty’s airway by tilting the head and lifting the chin, and give two breaths of artificial ventilation. 	Move your hands to the casualty’s chest, and give 15 chest compressions. 	Return to the head and give two more ventilations. 	Give 15 further compressions. 	Continue to give two ventilations every 15 compressions until professional help arrives.                                  For two first Aiders: 	One person should go to summon help while the other immediately starts CPR. 	Then, either proceeds as above, each person taking it in turn, or, while one of you gives chest compressions, the other can give breath of artificial ventilation after every five compressions. 	Pause to ensure that the casualty’s chest rises, but do not wait for the chest to fall before continuing with chest compression.

THE FIRST AIDER SHOULD 1. Preserve life. 	Pay strict attention to safety. 	Follow the ABC of resuscitation. 	Look for and control any major bleeding. 2 Limit the effects of the condition 	Make a diagnosis of the illness or injury, if possible, by means of a thorough examination. 	Treat casualties in a sensible order of priority. 	Treat multiple injuries in a sensible order of priority. Remember the possibility of “hidden” secondary illnesses or conditions. 3. Promote the casualty’s recovery. 	Relieve any anxiety, pain, and discomfort. 	Arrange for appropriate medical attention.

FIRST AIDER SHOULD FOLLOW: 	Making a diagnosis. 	History. 	External clues. 	Symptoms and Signs. SYMPTOMS:

Signs:

Your sense of touch may reveal these signs:

You may hear these signs: 	Noisy distressed breathing. 	Groaning. 	Sucking sounds (Chest Injury) 	Response to touch. 	Response to speech.

Your sense of smell may detect these signs. Remember to smell the casualty’s breath:

TIP-TOE SURVEY: It should be routine & should be remembered. You may need to move or remove clothing, but bear in mind that, during every stage of your examination, you should try not to move the casualty more than it is absolutely necessary. Use both hands, and always compare one side of the body with the other, since any swelling or deformity may be revealed much more clearly. SKULL & SCALP: Run your hands over the scalp to find bleeding, swelling, or any soft area or indentation that might indicate a fracture. Handle the head and neck very gently. NOSE: Check for any sign of blood or clear fluid(or a mixture of both) that might indicate damage inside the skull. EYES: Examine both eyes together, noting the size of the dark circular centre(Pupils) and they are equal in size. Look for any foreign body, wound, or bruising in the whites of the eyes. EARS: Speak to the casualty. Ask if she can hear in both ears. Look for blood or clear fluid(Or a mixture of both) coming from either ear canal that might indicate damage inside the skull.

MOUTH: Record the rate, depth, and nature (easy or difficult, noisy or quiet) of breathing. Note any odour on the breath. Look and feel inside the mouth for any thing that might endanger the airway. If dentures are intact and fit firmly, leave them in place. Look for any wound in the mouth or irregularity in the line of the teeth. Examine the lips for burns or discoloration, particularly blueness (which indicates low blood oxygen) FACE”: Note the color, the temperature, and state of the skin. For example, the closed eyes, open mouth and noisy breathing of unconsciousness may be accompanied by the pale, cold, Sweaty skin that indicates shock, or the flushed, hot face of stroke or fever. NECK: Loosen clothing around the neck. Remove a cravat or choker to look for a stoma – a hole in the neck left by a surgical operation. Check if any warning medallion is being worn. Take the carotid pulse, recording its rate, strength, and rhythm. Run your fingers down the spine from the base of the skull to between the shoulders, checking for irregularity or tenderness. Look for bruising.

TRUNK: Ask the casualty to breathe deeply, and observe whether the chest expands evenly, easily, and equally on the two sides. Check both collarbones and shoulders for deformity, irregularity, or tenderness. Feel the ribcage for similar abnormalities, and inspect the chest for any wound. Gently feel the soft part of the abdomen to discover any wound, rigidity, or tenderness. Feel both sides of the pelvic bones, and gently “rock” the pelvis to discover any sign of fracture. Note any incontinence or bleeding from the orifices.

BACK AND SPINE: If you have noted impaired movement or sensation in the limbs, you should not move the casualty to examine the spine. Otherwise, without causing undue disturbance, gently pass your hand under the hollow of the back and feel along the spine, checking for swelling and tenderness. UPPERLIMBS: Check movement and sensation in both arms. Ask the casualty to bend and straighten the fingers and elbows. Take her hands – can she feel normally? Note the color of the fingers. Look for bruising, swelling, or deformity, and for needle marks on the forearm. Look for a warning bracelet. LOWER LIMBS: Ask the casualty to raise each leg in turn, and to bend and straighten ankles and knees. Look and feel for any wound, swelling, or deformity. FEET: Check movement and feeling in all the toes. Look at their color- blueness of the skin (Cyanosis) may indicate a circulatory disorder or cold injury. REMOVE CLOTHING;

EMERGENCY ACTION In any given situations you must first take 3 essential steps. 01Look for danger                     02Remove any danger 03Assess the casualty. An unconscious casualty always takes priority Even if resuscitation is not necessary, an unconscious person needs immediate attention to ensure that he or she can breathe. Only then you begin to assess and treat any injuries, and any other, conscious casualties.

-ASSESSING THE CASUALTY

1.	Check for consciousness. Shout, “Can you hear me”? Or “Open your eyes!” Carefully shake the casualty’s shoulders. An unconscious casualty will not respond. 2.	Open an unconscious casualty’s air passage Remove any obvious obstruction from the mouth. Place two fingers under the point of the chin, and lift the jaw. At the same time, place your other hand along the casualty’s                    forehead, and tilt her head back. 3.	Check for breathing. Placing your head near the casualty’s nose and mouth: •	Look along the chest to see if there is any movement. •	Listen for sounds of breathing. •	Feel for breath on your cheek. Check for 5 seconds before deciding breathing is absent. 4.	Check for a pulse. With the head tilted back, feel foe Adam’s apple with two fingers. Slide your fingers back in to the gap between the windpipe and the muscle that runs beside it, and feel for 5 seconds for the carotid pulse.

Dr.Esmark (1823 –1908) started the first aid

•	He wrote two books on first aid •	1. First aid in wars •	2.First aid to wounded persons •	Dr.Mayor--- Switzerland •	He invented Triangular Bandage •	Dr.Esmark brought the importance to it.

SAINT JOHN AMBULANCE ASSOCIATION •	Formed in the year 1877. •	Giving training to men & women for wounded persons •	To teach First Aid to students. And supplement the relevant material. •	Brought First Aid book in the year 1878. •	First aid coined in the year 1879. •	First Aider – 1894

Other associations •	Saint Andrews Association -- 1822 •	Saint John Ambulance Association -- 1882 •	Saint Jock Association -- 1899

•	With these there is always •	RED CROSS SOCIETY--1870. August •	Victoria Rani of England started. •	Aim is one – Help the injured persons.

Scope of first Aid •	Diagnosis •	Treatment •	Disposal

Diagnosis •	History •	Symptoms •	              1. Pain •	              2. Shivering •	              3. Faintness etc •	Signs •	              1. Paleness •	              2. Swelling of parts injured •	              3. Bleeding •	              4. Deformity of limbs.

TREAT MENT »	MAIN IDEAS

•	1. Remove the casualty from danger •	2. See that casualty is comfortable •	3. Following conditions require prompt action •	             a. Failure of breathing •	             b. Stoppage of Heart •	             c. Severe bleeding •	             d. Shock •	             e. Poisioning •	             f. Major burns •	             g. Head Injuries •	             h. Fractures •	4. Continue treatment until the Doctor takes charge.

Disposal •	The earliest Doctor takes charge the greater the chance of recovery. •	Inform to family.

PRINCIPLES OF FIRST AID

GETING HELP

•	Need to state – •	 Exact location •	 Number of Casualties •	 Type of Incident e g RTA / Severity

WHAT TO DO IN AN EMERGENCY

•	ASSESSMENT OF- HAZARDS •	 RISK OF CONTAMINATION •	 AVAILABILITY OF HELP

AIRWAY

•	Look in mouth – use little finger to remove any debris •	Open airway by tilting head and lifting chin – this lifts the tongue from the back of throat preventing obstruction •	 If neck injury suspected minimum tilt to allow unobstructed breathing

RESPONSE

CHECK BREATHING

•• Look •• Listen •• Feel •	SHAKE AND SHOUT-Are you ok? •	Call for help •	 Check response - A.V.P.U. •	Alert •	Voice •	Pain •	Unconscious

MANAGEMENT OF UNCONSCIOUS CASUALTY

•	 ASSESS •	 RESPONSE-Shout & Shake •	 A.B.C. •	 HEAD TO TOE EXAMINATION •	 RECOVERY POSITION

PLAN OF ACTION

•	 NO Breathing / Signs of circulation •	PRESENT •	 NO COMPRESSIONS •	 CONTINUE MOUTH to MOUTH •	(Rescue Breathing) •	 Re-Check A, B, C every minute

PRIMARY SURVEY

•	To identify Life Threatening Conditions •	Assess •	Response •	Airway •	Breathing •	Signs of Circulation

PLAN OF ACTION

•	 NO Breathing/Signs of Circulation ABSENT •	 CARDIO PULMONARY RESUSCITATION LOOP •	Rescue Breaths 2: 15 Chest Compressions

CHAIN OF SURVIVAL

•	 ASSESS •	 RESPONSE •	 AIRWAY •	 BREATHING •	 NO BREATHING •	 Go for help NOW •	 2 BREATHS + SIGNS OF CIRCULATION

CARDIAC ARREST

•	 Continue CPR at 2: 15 until •	 Qualified help arrives •	 Patient recovers •	 You are too exhausted to continue

STRUCTURE & FUNCTIONS OF HUMAN BODY

•The skeleton is the framework of the human anatomy, supporting the body and protecting its internal organs. •206 compose the skeleton, about half of which are in the hands and feet. • Most of the bones are connected to other bones at flexible joints, which lend the framework a high degree of flexibility.

	Only one bone, the hyoid, is not directly connected to another bone in such an articulation. 	 It anchors the tongue and is attached to the styloid processes of the skull by ligament. 	 The skeletons of male and female bodies are essentially the same, with the only noteworthy exceptions being that female bones are usually lighter and thinner than male bones, and the female pelvis is shallower and wider than the male's. This latter difference makes childbirth easier.

Skull •The skull is one of the principle groups of bones in the human anatomy. •The skull consists of twenty-six bones: eight bones form the cranium, •which houses the brain and ear ossicles, plus fourteen facial bones, which form the front of the face, jaw, nose, orbits, and the roof of the mouth, •Three more bones make up the inner ear ossicles, and one more, the hyoid bone, is in the neck and is attached to the temporal bone by ligaments and anchors the tongue.

•The skull is the skeleton of the head and is made up of the following bones: 	One on the top called Dome. 	One in the front corresponding to the face called Frontal. 	Two-one on either side called the Parietals. 	Two-one on either side below the Parietals called Temporalis. 	One behind corresponding to the back of the head is called Occipital. 	Two forming roof of the mouth or the Upper Jaw. Skull Cavity Contains Brain Emerges Spinal Cord from Foramen Magnum (a big hole in the base of skull) continuous as spinal cord in backbone.

Back Bone or Spine (Vertebral Column) •	It consists of thirty three •	Cervical --07 •	Thoracic - 12  Separate •	Lumbar -- 05 •	Sacral 05    fused •	Coccyx --- 04 •	In between each pair of vertebrae there is a thick space called “Disc” which allows movement as well as shock absorber. Central canal through which spinal cord passes and carries nerve impulses to and from the Brain. •	Damage to the spinal cord results in inability to transmit and receive nerve impulses to and from the specific area supplied by the damaged section of the spinal cord, and all sections below it, resulting in paralysis and numbness. •	Inflammation of the spinal covering is a condition called spinal meningitis. Ribs & Breast Bone (Sternum) •	12 pairs attached to the corresponding vertebrae at the back. •	1 to 7 pairs – attached Breast bone front •	8 to 10 pairs – attached to ribs above. •	11 & 12 pairs – have no attachment in front i.e. Floating Ribs.

The Upper Limbs&Shoulder •	1.Clavicle ( collar bone) •	2. Scapula ( Shoulder blade) •	Bones In Upper Limb •	1. Humerus ( Upper arm bone) •	2. Fore arm bones ---two •	 a) Radius – Outer side of fore arm •	  b) Ulna    -- Inner side of fore arm. •	The joint between upper arm & fore arm is called Elbow joint. . There are 8 carpal bones at the Wrist 5 Meta carpal bones in the palm of the Hand. 3 small bones in each finger called Phalanges. 2 bones for each Thumb Pelvis •	The pelvis creates the basin of the lower abdominal cavity. •	Three separate bones, which become fused, form it: the ilium, the ischium, and the pubis. 2 Hip bones one on either side joined together form the Pelvis. The Pelvis forms a basin – shaped cavity, which contains intestines, Urinary bladder and reproductive organs. There are two sockets one either side of the Pelvis, where the thigh bones join forming Hip joint Lower Limbs •	Femur ( Thigh Bone) Longest & Strongest bone in the body. Upper end Part of Hip joint Lower end Part of Knee joint. •	Patella ( Knee cap) Small bone over the front of the Knee joint lying loosely in the muscles, ligaments and under the skin. Leg •	1. Tibia ( Shin Bone) •	2. Fibula ( Brooch Bone) •	Tibia: Extends from Knee joint to Ankle joint. •	Fibula: Lies on the outer side of Tibia. It does not participate in the formation of Knee joint, But lower end forms outer part of the ankle joint. Foot •	 Tarsals 7 Irregular bones at the “Instep” Largest, the heel-bone and the upper most forms the lower part of ankle joint. •	Meta tarsals – 5 long bones in front of the instep support the toes. •	Phalanges -- 14  in number, 2 in big toe and three in each of other 4 toes. Joints •	Joints are at the junction of two or more bones. •	There may be no movement as in skull •	Or there may be movements as in Knee, Elbow, Shoulder and Hip joints. •	Ends of the bones are covered by cartilage and are overall again encased in capsule with some lubricant material inside the joint.

Muscles •	Primarily meant to produce movement of the Limbs & Organs. •	There are Broadly two types of muscles 1. Voluntary – cause movement under the will. 2. In voluntary – with out the will like      Heart, lungs, brain, kidneys etc. Nerves & Stimuli •	 The muscles go in action called contraction by stimuli of nerves arising from brain & spinal cord carrying motor impulses. •	The damage to the nerves results in paralysis of the muscles. Ligaments •	Thickened portions of the joint capsule are called ligaments. •	They check movements beyond normal permissible limits. •	If there is simple injury to the ligaments of the joints, it is called sprain. Connective Tissue

•	Consists of yellow elastic & white fibrous tissue intermixed  in varying proportions. •	Present in many parts of the body & forms a layer between the skin and underlying muscles all over the body. •	Fat being contained between its meshes, often in large quantities •	Chief use is bind parts together. Skin •	Covers the whole body & Protects underlying structures. •	Two layers. 1. Cuticle – outer hard layer. 2. Dermis (True Skin) inner layer •	The skin has the largest surface area of any organ in the body and is the heaviest. •	The skin protects the internal organs of the body against infection, injury, and harmful sunrays. •	It also plays an important role in the regulation of body temperature. Although the skin of an average-sized adult may weigh as much as twenty pounds, it is only paper thin in some places and not much thicker in others. Trunk •	Diaphragm (arched muscular partition) Divides Trunk in to two cavities. 1. Upper, chest (Thorax) 2. Lower (Abdomen) Eyes •	When you look at something, the light rays reflected from the object enter the eye. •	The light is refracted by the cornea and passes through the watery aqueous humor and pupil to the lens. •	The iris controls the amount of light entering the eye. •	Then the lens focuses the light through the vitreous humor onto the retina, forming an image in reverse and upside-down. •	Light-sensitive cells in the retina transmit the image to the brain by electrical signals. •	The brain "sees" the image right side up.

Ears •	The ear is divided into three parts: the outer ear, the middle ear, and the inner ear. •	The outer ear has two parts; the pinna and the external auditory canal. •	The outer ear collects and channels sound. •	The middle ear, or tympanic cavity, is a tiny cavity hollowed out of the temporal bone. •	It is an intermediary in the processing of sound energy. It is responsible for increasing the intensity of incoming sound waves and transforming them into mechanical vibrations that can easily travel through the inner ear. •	he inner ear has two parts. One is made of bone, the other of a membrane that lies inside the bone. Both have complicated shapes, and for this reason they are called labyrinths. •	Each labyrinth has three parts: vestibule, semicircular canals, and cochlea. •	he inner ear contains the receptor cells, which receive the mechanical vibrations and transmit them to the brain.

Tongue •	Muscular organ lies in floor of the mouth •	Assisting in          1. Tasting 2. Mastication 3. Swallowing of food. •	In Unconscious casualty falls on his back, the tongue tends to obstruct the throat & prevent breathing.

THYROID GLAND

•	The thyroid gland is one of the glands of the endocrine system which lies outside of a body cavity. •	 It is a small gland weighing about 1 ounce (28 grams) and is located in the neck, just below the larynx. •	This gland secretes two hormones: thoroxine and calcitonin (thyrocalcitonin). •	Thoroxine effects the growth rate and metabolism of all of the body's cells. •	 One of the main components of thoroxyne is iodine, an important body building agent. Babies cannot grow properly without iodine. In older people, iodine deficiency causes hair loss, slowed speech, and drying and thickening of the skin. •	 An average adults iodine requirement is only about a millionth of an ounce (0.00003 grams) per day but it is vital to the delicate balance between health and sickness. •	Thyroxine also controlls temperature. •	People with overactive thyroid glands tend to feel uncomfortably hot in cool conditions, while those whose thyroid gland is under-active tend to feel cool even on hot days. •	 The other hormone produced by the thyroid gland, calcitonin, tends to decrease the amoumt of calcium in the blood, the opposite effect of parathormone from the parathyroid glands. Calcitonin functions to help maintain homeostasis of blood clavium. It prevents a harmful excess of calcium in the blood, called hypercemia, from developing.

BLOOD

•	Blood is one of the three main fluids in the body (the other two are the fluid around cells and the fluid inside the cells). •	 It supplies oxygen, transports nutrients, waste, and hormonal messengers to each of the sixty billion cells in the body, as well as defending the body against foreign material. •	There are close to 30 trillion blood cells in an adult.

•	Each cubic millimeter of blood contains from 4 1/2 to 5 1/2 million red blood cells and an average total of 7,500 white blood cells.

•	Blood has four main components: •	Red blood cells, white blood cells, platelets, and liquid plasma. •	Since both red and white blood cells are continually being destroyed, the body must continue to produce new ones. •	About 2 1/2 million red blood cells die every second, at the same time, about 2 1/2 million new ones are created.

Plasma •	Albumin, the most plentiful, is similar to egg whites and gives blood its gummy texture. •	The globulins, three in number: alpha, beta, and gamma, transport certain proteins. •	They number half the albumin proteins found in plasma. •	Gamma globulins are the antibodies of the blood, giving immunity to disease. •	Only 3% of plasma is made up of fibrinogen. It is an important link in the chain of reactions that leads to blood clotting.

RBC •	Red blood cells, called erythrocytes, carry 99% of the oxygen the body needs. •	 Although plasma circulates throughout the body, it can only carry about one percent of the oxygen that the body needs. •	 Red blood cells are the most abundant cells in the body, constituting about 45% of the blood. •	Each cell is very small, about .008 centimeter (3/1000 of an inch) in diameter and shaped like a round cushion, with a hollow on each side. The rate of red cell formation is regulated by a messenger hormone called erythropoietin which is produced in the kidneys. cell will only live for 120 days. •	About five million red blood cells are destroyed every second. Normal red blood cell production depends upon the body having an adequate supply of iron and two main vitamins: B12 and folic acid. •	There are many diseases due to deficiencies in red cells, they are collectively known as anemia.

WBC •	White blood cells, called leukocytes, are outnumbered by the red blood cells 600 to 1. •	These cells are spherical in shape and slightly larger than red blood cells. There are five types of leukocytes. •	 Three of the five have a granular appearance. These are the neutrophils, eosinophils, and the basophils. •	The other two, the lymphocytes and monocytes, have smooth, non-granular bodies. •	 The main function of the leukocytes is to provide a defense against "foreign" material (infectious agents, foreign bodies, abnormal proteins). •	Lymphocytes are the smallest white blood cells and are a part of the immune mechanism.

•	Red bone marrow continually produces white blood cells, except lymphocytes and monocytes, and keeps a reserve ready in case of need. Lymphocytes and monocytes are produced by lymphatic tissue located in the lymph nodes and spleen. •	When a parasite or virus invades and begins to colonize, the reserves of white blood cells are released and the manufacturing of large quantities of the appropriate white cells begins. •	It is this increased production that causes fever. •	Because white blood cells are very specific for various illnesses, their count can help doctors diagnose patients.

PLATELETS 	Platelets are tiny specialized cells that are activated whenever blood clotting or repair to a vessel is necessary. Although they are often called cells, they are really fragments of other cells.

	They are made in bone marrow and are much smaller than red blood cells. A drop of blood contains some 15 million platelets. 	When a blood vessel is cut, platelets rush to the vessel and swell into odd, irregular shapes, grow sticky and clog at the cut, creating a plug. 	If the cut is too large for platelets, they send out signals to initiate clotting by releasing a hormone called serotonin, which stimulates blood vessels to contract thus reducing the flow of blood. ABDOMEN

•	The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal, and oblique. •	These muscle fibers allow the elasticity and the contractions of the stomach which help digestion

DRESSINGS

A dressing is a protective covering applied to a wound to 1.	 Prevent infection 2.	Absorb discharge 3.	Control bleeding 4.	Avoid further injury An efficient dressing– 1. Sterile 2. Porosity –allow oozing & sweating Types of Dressing •	1. Adhesive --- Absorbent gauze of cellulose •	2. Non adhesive a. Ready made sterile b. Gauze – large wounds. c. Improvised – Soft, clean material Application of Dressings 	Great care must be taken in handling & applying dressing. Wash your hands thoroughly. 	Avoid touching any part of the wound with the fingers of any part of the dressing, which will be in contact with the wound. 	Do not talk or cough over the wound or the dressing. 	Dressing must be covered with adequate pads of cotton wool. Extending well beyond them and retained in position by a bandage or strapping. 	If a dressing adheres to the wound do not try to remove it. 	Cover it with sterile dressing after cutting away whatever can be removed.

Bandages •	Made from Flannel Calico Elastic net Special paper

Uses of Bandages 	Maintaining direct pressure over a dressing to control bleeding. 	Retain dressings and slings in position. 	Prevent or reduce swelling. 	Provide support for a limb or joint. 	Restrict movement 	Assist in lifting and carrying casualties.

	Bandages should not be used for padding when other materials are available. 	Bandages should be applied from enough to keep dressing and splints in position but not so tight as to cause injury to the part or to impede the circulation of the blood. 	A bluish tinge of the finger or nails may be a danger sign that the bandages are too tight; loss of sensation is another sign.

Types of Bandages Two types 1.	Triangular 2.	Roller

Triangular Bandage

Made by cutting a piece of calico 100 sq cm from corner to corner so as to give two bandages.

Uses of Triangular •	Whole cloth spread out fully •	As a broad bandage •	As a narrow bandage •	As a smaller size

Butterfly Bandage Standard bandages come in a variety of shapes and sizes. The butterfly bandage shown here is used to hold together the edges of a cut.

SLINGS USES 1.To support injured arms 2.To prevent pull by upper limb of injuries to chest, shoulder and neck How to Make a Sling To make a sling, cut a piece of cloth, such as a pillowcase, about 40 inches square. Then cut or fold the square diagonally to make a triangle. Slip one end of the bandage under the arm and over the shoulder. Bring the other end of the bandage over the other shoulder, cradling the arm. Tie the ends of the bandage behind the neck. Fasten the edge of the bandage, near the elbow, with a safety pin.

Different types of slings •	The Arms Sling •	Collar & Cuff sling. •	Triangular Sling. •	Improvised Slings Arm Sling Used in 1.Cases of # ribs 2.Injured arms, wrist, and hands after application of splints plaster casts& bandaging Collar & cuff •	Support the wrist only Triangular Sling •	Treating the # collar bone •	Helps to keep the hand raised high up giving relief from pain due to the #. Bandaging with Triangular sling 1.For the Scalp 2.For fore head, eye, cheek, or any part which is round in shape. 3.For back of the chest 4.For the shoulder. 5.For the elbow. 6.For the hand. 7.For the hip or groin. 8.For the Knee. 9.For the foot. 10.Stump.

Roller Bandages 	Used in hospitals & first aid posts. 	Made of flannel or cotton material with local mesh 	Various lengths & widths. Width of roller bandages 	One inch for fingers & toes. 	2.5 inches for head & arm. 	3.5 inches for leg. 	6 inches for body.

Roller bandages •	To keep dressings in position. •	The rolled part is called Head. •	Unrolled portion is called --- Tail. •	Applied firmly & evenly.

General rules for application of roller bandages 1.	Face the patient. 2.	When bandaging left limb, hold the head of the bandage in the right hand and vice versa. 3.	Apply the outer side of the bandages over the pad and wind it round the injury twice so that it is firm. 4.	Bandage from below upwards over the limb. Also make it a rule to apply bandage from the inner side to the outer side. 5.	See that bandage is neither too loose nor too tight. 6.	Roll bandage so that each layer covers two- thirds of the earlier layer. 7.	Fix the bandage by pinning it up or using adhesive plaster. the usual practice of tearing the final end in to two long tails and tying them up is quite satisfactory & practical. Application of roller Four methods. 	Simple Spiral– finger or uniform surface. 	Reverse spiral. - Thick –leg, fore arm. 	Figure of Eight. Joints like elbow & knee Spica --- Bandaging hip, shoulder, groin & thumb

Respiratory System Physiology

•	Breathing allows CO2 to be expelled and O2 to be exchanged into the blood. Without an open Airway breathing cannot occur •	Air is drawn into the body by negative pressure in the pleural cavity created by muscular contraction of the diaphragm

Respiration Air pathway Nose --- Pharynx (Throat) Mouth– Larynx Trachea  (Wind Pipe) Bronchi (Two air tubes) Bronchioles Alveoli Gaseous exchange takes place at Alveoli. Respiration--- Under the control of Autonomic Nervous system Resp.rate    - 15 to 18 / mt

Asphyxia -- Lungs do not get sufficient supply of Air for breathing.

Causes of Asphyxia I. Conditions affecting the air passages. A)	Spasm 1.	Food going down the wrong way ( I.e.Air passage) 2.	Water getting in to air passage, as in Drowning. 3.	Irritant gases ( coal gas, motor – exhaust fumes, i.	smoke, sewer and closed granary gas, gas in deep ii. unused wells etc.,) getting in to the air passage. 4.	Bronchial asthma. B)	Obstruction 1.	Mass of food or foreign body, like artificial teeth etc., in the air passage. 2.	Tongue falling back in an unconscious patient. 3.	Swelling of tissues of the throat as a result of scalding (boiling water) or injury, burns, and corrosives. C)	Compression. 1.	Tying a rope or scarf tightly around the neck causing Strangulation. 2.	Hanging or Throttling (applying pressure on wind pipe) 3.	Smothering like overlaying an infant, and unconscious person lying face downwards on a pillow, or plastic bags, or sheet covering face completely for some time II Conditions affecting respiratory mechanism.      1. Epilepsy, tetanus, rabies etc.      2. Nerve diseases causing paralysis of chest wall or diaphragm III. Conditions affecting Respiratory centre.      1. Morphea, barbiturates (sleeping tablets)      2. Electric shock, stroke. IV. Compression of the Chest.       1. Fall of earth or sand in mines, quarries, pits, or compression by grain in a silo, or big beams and/or pillars in house/collapse.        2. Crushing against a wall or other barrier or pressure in a crowd.        3. Lack of Oxygen at high altitudes with low atmospheric pressure. Acclimatization-(gradual ascent) is necessary.

Signs of Asphyxia I Phase 1. Rate of breathing increases. 2. Breath gets shorter. 3. Veins of the neck become swollen. 4. Face,lips,nails, fingers and toes turn blue. 5. Pulse gets faster and feebler. II Phase. 6. Consciousness is lost totally or partially. 7. Froth may appear at the mouth and nostrils. 8. Fits may occur.

Management of Asphyxia 1. Remove the cause if possible, or, remove the casualty from the cause. 2. Ensure open airway to allow the air to reach the lungs. 3. Prevent damage to the brain and other vital organs (which will occur due to lack of oxygen) 4. Keep the body warm by light blankets. 5. Provide shelter to casualty,

DROWNING

Result of complete immersion of the Nose and Mouth in water (or any other liquid). Water enters the windpipe and lungs, clogging the lungs completely. Death from drowning usually occurs not because the lungs are full of water, because throat spasm prevents breathing. Usually only a relatively small amount of water enters the lungs. The water that often gushes out of a rescued casualty’s mouth comes from the stomach, rather than the lungs, and should be allowed to drain naturally. Attempts to force water from the stomach may result in stomach contents being inhaled. A drowned casualty may be suffering the effects of cold as well as asphyxia and may need to be treated for hypothermia. The casualty should always receive medical attention. Any water entering in the lungs will cause irritation and, even if the casualty appears to recover rapidly and fully at the time, swelling of the air passages (“Secondary drowning”) may still develop some hours later. …

Management: Aim is to drain of water from lungs & give artificial respiration. 1.	Act quickly. 2.	Turn the patient face down with head to one side and arms stretched beyond his head. 3.	Raise the middle part of the body with your hands round the belly. This is to cause water to drain out of the lungs. 4.	Give artificial respiration until breathing comes back to normal. This may have to go on for as long as two hours. 5.	Remove wet clothing. 6.	Keep the body warm, cover with blankets. 7.	When victim becomes conscious, give hot drinks viz. coffee or tea. 8.	Do not allow him to sit up. 9.	After doing the above, remove quickly to hospital as a stretcher case.

STRANGULATION AND HANGING.

Pressure on the outside of the neck squeezes the airway and blocks the flow of air to the lungs.

A) Strangulation is usually the result of throttling by hands, or a rope or scarf being tied tightly round the neck.        It occurs when the air supply is cut off by a constriction around the neck. B) In hanging the fracture of spine causing compression or tear of the spinal cord is more important. It is suspension of the body by a noose around the neck. C) Throttling is cutting off the air supply by squeezing a person’s throat.        Hanging & Strangulation may occur accidentally – for example, by a tie or clothing caught in machinery. Hanging may also cause a broken neck.

RECOGNITION:

There may be 	A constricting article around the neck. 	Marks around the casualty’s neck where a constriction has been removed. 	Rapid, distressed breathing, impaired consciousness, and blueness of the skin (cyanosis). 	Congestion of the face, with prominent veins and possibly, tiny red spots on the face or on the whites of the eyes. Management

	Quickly remove any constriction from around the casualty’s neck, supporting the body if it is still hanging. 	If the casualty is unconscious, check breathing and pulse, and be prepared to resuscitate. Place her in recovery position. 	Seek medical aid, even if recovery seems complete. 	To do above do not wait for the policeman.

CHOKING (ASPHYXIA DUE TO OBSTRUCTION IN WINDPIPE.)

	      This is most common with children. A marble, a weed or a button may get struck in the air passage. In adults too, food may go down the wrong way and choke him. 	The aim or First Aid is to remove the foreign body or obstruction. 	Management in adults :Heimlich procedure infant: upside down.

HEIMLICH MANEUVER

Heimlich Maneuver on a Child

•	Stand behind the child. •	With your arms around his or her waist, form a fist with one hand and place it, thumb side in, between the ribs and waistline. •	Grab your fist with your other hand. •	Keeping your arms off the child's rib cage, give four quick inward and upward thrusts. •	You may have to repeat this several times •	Until the obstructing object is coughed out.

Heimlich Maneuver on an Infant

Place the infant face down across your forearm (resting your forearm on your leg) and support the infant’s head with your hand. Give four forceful blows to the back with the heel of your hand. You may have to repeat this several times until the obstructing object is coughed out.

If this does not work, turn the baby over. With two fingers one finger width below an imaginary line connecting the nipples, give four forceful thrusts to the chest to a depth of 1 inch. You may have to repeat this several times until the obstructing object is coughed out.

HEIMLICH MANEUVER ON AN ADULT

If the person is sitting or standing, stand behind him or her. Form a fist with one hand and place your fist, thumb side in, just below the person’s rib cage in the front. Grab your fist with your other hand. Keeping your arms off the person’s rib cage, give four quick inward and upward thrusts. You may have to repeat this several times until the obstructing object is coughed out.

If the person is lying down or unconscious, straddle him or her and place the heel of your hand just above the waistline. Place your other hand on top of this hand. Keeping your elbows straight, give four quick upward thrusts. You may have to repeat this procedure several times until the obstructing object is coughed out.

SWELLING WITHIN THE THROAT

Occur due to         1. Trying to drink hot liquids. 2. Swallowing corrosive poisons. 3. Inflammation. Management 	Make the patient sit up. 	If breathing continuous normal or is restored to normal give ice to suck, or cold water to sip. 	Butter,olive oil, or medicinal parafin can be given. 	Apply cloth wrung out of hot water to the front of the neck. 	If breathing has stopped give artificial respiration.

SUFFOCATION BY SMOKE

	Protect yourself by a towel or a cloth (preferably wet) over your mouth and nose.

	Keep low and remove casually as quickly as possible from the area.

SUFFOCATION BY POISONOUS GASES

Carbon monoxide (lighter than air) 	This gas present in                 Car exhaust fumes House hold coal gas During incomplete combustion of charcoal stoves. Coal mines.

The First Aid treatment consists of 	   Removing the person from the area. 	   Applying artificial respiration. 	   Giving pure Oxygen Management of “CO” poisoning 	Ensure circulation of fresh air before entering the room by opening the doors & windows. 	Before entering the enclosed space take two or three deep breaths and hold your breath as long as you can. 	Crawl along the floor ( as gas is lighter than air) 	Remove the casualty as quickly as possible to fresh air. 	Loosen his clothes at neck and waist and give artificial respiration, if asphyxiated.

CARBON DIOXIDE AND OTHERS ( HEAVIER THAN AIR) 	Gas is found in         1. Coal mines 2. Deep unused wells 3. Sewerages Various other gases such as leaking refrigerator gases; compressed gases used for cooking and lighting may cause suffocation. CARBON DIOXIDE May cause 	Breathlessness. 	Headache. 	Dizziness. 	Leading rapidly to unconsciousness. 	Ensure circulation of fresh air before entering the room by opening the doors & windows. 	Before entering the enclosed space take two or three deep breaths and hold your breath as long as you can. 	Enter in upright position (as the gas is heavier than air and collects near the floor) 	Remove the casualty as quickly as possible to fresh air. 	Wherever ventilation is not possible and deadly poisonous gas is suspected, use a gas mask to protect yourself.

BREATHING DIFFICULTIES:

These may be caused by: I.	Chronic illness a)	Emphysema II.	Infections in the respiratory system. a)	Croup or bronchitis. III. Allergic reactions. a)	Respiratory – hay fever b)	Generalized – anaphylactic shock.

Sudden illness may be the result of

a)	Psychological stress ( Hyperventilation) b)	Chest injury. c)	Asthma.

Prompt First aid can do much to help in breathing & case distress.

ASTHMA 	This is a condition where sudden constriction of airways causing difficulty in breathing out, occurs. 	Allergy 	Infection 	Anxiety 	Tension Can trigger an attack. RECOGNITION: There will be 	Difficulty in breathing, with a markedly prolonged breathing-out phase. There may be 	Wheezing as the casualty breaths out. 	Distress and anxiety: the casualty may speak only with difficulty and in whispers. 	Blueness of the skin(Cyanosis) 	In a sever attack, the effort of breathing will exhaust the casualty. Rarely, he or she may become unconscious, and stop breathing altogether. Asthma Management

	Reassure the patient. 	Make him sit up in bed or chair and allow him to lean forward with a couple of pillows and/or a small table on which to rest his head. 	Ensure fresh air by opening the windows. 	Seek medical aid from a nearby Doctor.

Asphyxia of severe degree with unconscious 	The tongue may have fallen back in to the throat. 	Vomit or Spittoon may collect in the throat. 	FB like weed or mud

Begin to work immediately as every minute counts. Do not delay. Tt when not Breathing 	Loose all cloth at waist, chest and neck. 	Tilt the head back wards, while supporting the back of neck with your palm. Thus the air passage will be cleared & casualty begin to breath after a gasp. pass resuscitube.If one available readily. 	If breathing does not begin after the above Tt, help movement of chest & lungs 4 or 5 times. This enough for breathing. 	Still not success start Mouth to mouth.

ARTIFICIAL RESPIRATION

	Mouth to Mouth    Easiest way 	Mouth to Nose 	Ambubag              Mechanism same as                                     mouth to mouth Other methods: 1.Holgar nelson 2. Shefar                     Mostly out dated 3. Silvester

Mouth to Mouth

1.	Place the casualty on his back. Hold his head tilted back. 2.	Take a deep breath with mouth open widely. 3.	Keep nostrils of casualty pinched. 4.	Cover the moth of the casualty with your mouth smugly. 5.	Watching the chest, blow in to his lungs, until the chest blows up. With draw your mouth, note the chest falls back. 6.	(It is hygienic to cover the mouth of the casualty with your Kerchief or some clean cloth) 7.	Repeat the above 15 to 20 times a minute. 8.	If chest does not rise, see for obstruction. 9.	Use Mouth to nose if mouth-to-mouth is not possible. Mouth should be closed by thumb. 10.	If heart is working continue CPR until normal breathing starts. Send for Ambulance. 11.	If the heart is not working, See for following: a) Face is blue or pale.  b) Pupils are dilated. c) Heart beat but pulse presents at carotid.

Heart is not working follow this: 	Place the casualty flat on his back on a flat surface (bench, table etc) 	Give a small hit with the edge of your hand on the lower and left angle of the sternum. This usually stimulates the heart to work. 	In case heart does not work, persists the striking for 10 – 15 seconds, at the rate of one stroke for second. Feel for the pulse becomes regular and continuous stop beating. 	All the while artificial respiration has to go on.

Imp notes 	Even if the casualty is breathing, but the breathing is not normal, it is wise to start artificial respiration. 	Do not begin thumping the heart or compression until you are sure that the heart has stopped beating.

EXTERNAL CARDIAC COMPRESSION

If there are two trained persons 	This should be go on along with artificial respiration. Therefore ask the First aider giving mouth to mouth breathing to sit to the right of the casualty and place your self on left side. 	Feel & mark the lower part of the sternum. 	Place the heel of your hand on the marked part(Make sure that palm & fingers are not on contact with the chest) 	Place the heel of the other hand over it. 	With your right arm, press the sternum backwards towards spine. (It can be pressed back 1 to 1.5 inches in adults) Imp: 1.	Adults should be given about 60 pressures a minute. 2.	Press firmly but carefully. Carelessness may cause injury to ribs & deeper structures. 3.	If the treatment is effective: a)	Co lour will become normal     b) Pupil will contract as improvement begins. c) Carotid pressure begins with each pressure. 4. When the pulse is not present continue compression till the patient reaches hospital.   Only one First aider Finish 15 compressions & 2 Inflations Two First Aiders 1– makes 5 hc then no. 2– 2 lung inflations     these are repeated. At the same time no.1 can watch pupils                            No.2 can feel carotid pulse.

AIRWAY EVALUATION

If victim is talking, crying or coughing the airway is open. •	If the victim is unconscious and on their back then the tongue is most likely blocking the airway. Two methods for opening the airway •	Head tilt, chin lift - no suspicion of spinal injury •	Jaw thrust – known or suspicion of spinal injury

Chin Lift and Head Tilt

Jaw Thrust

In these conditions Heimlich Maneuver should be done

If victim becomes unconscious

	Call EMS 	 Place victim on back and open airway 	 Look inside mouth – if cannot see anything do not do a finger sweep 	 Try to give rescue breaths 	 If these do not go in reposition the head and give another breath. 	 Perform abdominal thrusts

THE CIRCULATORY SYSTEM

	Blood circulates around the body in a continuous cycle, pumped by the rhythmic contraction/ relaxation, or beat, of the heart muscle. 	The blood circulates within a network of flexible tubes, known as blood vessels. 	There are three types of blood vessel: arteries, veins, and capillaries. 	The force with which the heart pumps the blood through the vessels and around the body is known as the “blood pressure”. 	The circulating blood distributes oxygen and nutrients to the tissues, and carries waste products away. 	HOW BLOOD CIRCULATES: 	Oxygenated blood is pumped out of the Heart to be circulated around the body. 	Blood that has given up its oxygen to the body tissues flows back to the heart. 	Deoxygenated blood is pumped by the heart in to the lungs, where it releases the waste gas, carbon dioxide, and takes up fresh oxygen. 	The newly oxygenated blood returns to the heart, ready to be pumped around the body again. 	The heart muscle contracts, forcing blood out of its big, thick walled pumping chambers (Ventricles); then relaxes, allowing replacement of blood to flow in to fill its collecting chambers (Atria).

	WHAT CAN GO WRONG: 	The amount of oxygen carried in the blood may be reduced, by a deficiency of red blood cells (Anemia), or by sufficient oxygen available in the lungs. 	Anemia makes the skin pale (pallor). 	Blood low in oxygen gives blue tinge to the skin (cyanosis). 	Continuously high blood pressure, produced by conditions such as hardening of the arteries (arteriosclerosis), may cause a blood vessel to rupture, resulting in internal bleeding. 	Poor circulation, hardened arteries, or narrowed blood vessels can contribute to the forming of a blood clot (Thrombosis). The clot may travel with in the circulatory system to lodge else where. This is known as Embolism. 	A fall in blood pressure (For example, due to bleeding) may prevent an adequate supply of blood, and therefore oxygen, to the vital organs. Shock may develop. SHOCK 	Life threatening. 	It is a condition not a disease. 	Prevention is best. 	 Can happen for any reason. 	Caused by the body shutting down the peripheral systems to protect the “core” elements the organs. 	Cardiovascular system failure. 	Lack of blood in the body. 	Insufficient blood pressure to pump blood. 	Insufficient oxygen intake. 	Develop in stages. 	An accident will not cause death but from the shock will

Factors to affect shock: A.	Fatigue. B.	Hot/cold temperatures. C.	Stress. D.	Dehydration. E.	Age. F.	Pain tolerance. Treating a shock victim: 1.	Lay casualty down & loose the restrictive clothing. 2.	Perform Primary Survey (Unconscious) 3.	Monitor vitals (Conscious) 4.	Give first aid if needed. 5.	Cover the casualty to maintain body heat. 6.	Elevate legs 10 –12 inches unless you suspect spinal # or broken bones. 7.	Provide the casualty with plenty of fresh air. 8.	If the casualty begins to vomit place them on their left side. 9.	Call the Ambulance. Types of Shock

	Cardiogenic – pump failure 	 Hypovolemic – loss of fluid 	 Neurogenic – pipes enlarge, too large for volume of fluid 	 Anaphylactic – loss of fluid and enlarged pipes 	 Septic – loss of fluid and enlarged pipes

Action in emergency: 1.	Assess the situation. 2.	Make the area safe. 3.	Give the emergency aid. 4.	Get help.

Priorities: 1.	Airway. 2.	Breathing. 3.	Circulation. 4.	Bleeding& Shock. 5.	Other injuries. WOUNDS - ANATOMY OF SKIN

Dangers of Wounds 	Wounds cause two great dangers:

	 1. Bleeding and 	 2. Infection

WOUNDS AND BLEEDING When any tissue of the body e.g.. Skin, muscle, bone etc., is torn or cut by injury, a wound is caused. There will be bleeding from the injured part and it also forms an Opening through which germs can get into the body. The depth of a wound is often more important than its area: small deep wounds caused by knives, bullets etc, are often the more dangerous.

Type of Wounds.

Incised Wounds Are caused by sharp instruments like knife, razor etc. The blood vessels are ‘clean out’ and so these wounds bleed very much. Contused Wounds. Are caused by blows by blunt instruments or by crushing. The tissues are bruised. Lacerated Wounds Are caused by machinery and Falls on rough surfaces, pieces of shells, claw of animals etc. These wounds have torn and irregular edges and they bleed less. Punctured Wounds They are caused by stabs by any sharp instruments like a knife or a dagger. They have small openings, but may be very deep. Bleeding 	Is the immediate danger and should be treated promptly. 	A wound is not initially infected even though it may be contaminated by the dirt and infected material, which contain germs. 	These germs are microscopic and not visible to naked eye. Infection only occurs after a lapse of time when the germs have time to multiply and invade the tissues. 	This time was formerly arbitrarily fixed at 6 hours but varies with the number of bacteria and their virulence and body resistance. P 	us formation is part of bodies method to fight the infection. 	Our aim as a first aider is to prevent infection occurring. We do this by promptly attending to wounds.

Bleeding (Hemorrhage) is a common cause of death in accidents. It is caused by the rupture; of blood vessels due to severity of the injury.

External and Internal Bleeding. External bleeding: Obvious. 	If the bleeding is form the surface of the body it is called external bleeding. Internal Bleeding: 	If the bleeding is within the chest, Skull or abdomen etc. it is called internal bleeding. This cannot be seen immediately, but later the blood may ooze out through the nose or ear, or coughed up from the lungs, or vomited from the stomach. 	Bruising, Painful tender, rigid abdomen, 	Bloody or black stools or vomit, 	Seen in conditions like broken ribs & Bruised Chest

Types of Bleeding.

Bleeding may occur from 	(A) arteries, Very fast, Bright red, squirting. 	 (b) Veins, -- Faster, dark red 	(c) Capillaries or from a combinations of the three. Slow & easily controlled

Bleeding from Arteries The blood comes out in jets because it corresponds to the beats of the heart in action. The blood will be bright red. Arteries are strong, muscular, elastic- walled vessels carry the blood away from the heart towards the tissues. This kind of bleeding may cause death very quickly.

Bleeding from Veins Veins are thin- walled vessels carry blood back to the heart. Blood is squeezed through the veins by the action of surrounding muscle, and is kept flowing towards the heart by one-way valves. Blood flows in a continuous stream. Dark red in co lour.

Bleeding from capillaries: Blood oozes out slowly. If it is on the surface of the body it is not at all serious.

Signs & symptoms of Bleeding 1. The casualty feels faint and may even collapse. 2. Skin becomes pale, cold and clammy. 3. Pulse gets rapid but very weak. 4. Breathing becomes shallow; casualty gasps for breath and sighs deeply. 5. There is profuse sweating. 6. The casualty feels thirsty. Management of Bleeding 1.	Minor bleeding: It results from injured capillaries. No need to fright. Bleeding stops it self or by firm Pressure & bandaging. 2. Major Bleeding: Result of an large blood vessel Suffer from some blood disease. Aims of First Aider is  1. To stop the bleeding quickly. 2. To get immediate Medical aid. 3. If necessary take the casualty to hospital for blood transfusion etc.

In the case of Severe external bleeding 	Bring the sides of the wound together and press firmly. 	Place the casualty in a comfortable position & raise the injured part (if no bone fracture suspected)

FIRST AID IN Bleeding 	-  Wash your hand thoroughly with soap and water. Do not wipe them dry. 	-  (Clean the external wound with plenty of good clean drinking water). Wipe gently the surrounding skin and remove dirt, sticking to wound. Use plenty of running water. 	-  Do not use any antiseptic in water. 	-  Dry the surrounding of the wound gently with dry sterile gauze of freshly laundered soft handkerchief. Dhoti. 	-  Pick away foreign material from the wound. 	-  Cover the wound with dry sterile gauze if available; otherwise use freshly laundered clean soft. Handkerchief, dhoti or another clothes. Do not let cotton come in contact with the wound. 	-  Bandage. 	-  Do not apply any antiseptic in large wounds. This may get absorbed and cause reactions. Please note that the wound itself has not been washed or touched in an attempt to clean.

INFECTION

	Is caused by germs getting into the body through the broken skin. 	The germs multiply in wound and make it infected or septic. 	They May then get into the blood stream and cause blood-poisoning (Septicemia).

Aims of first Aid.

The aim of first and is to stop bleeding and minimize the number of germs that get into the wound. We should remember that germs come from. 1.	The object that caused the wound (knife,stone,etc): 2.	The skin of the person: 3.	The clothes of the person: 4.	The hands of the First-Aider, 5.	Dirty dressing: 6.	The air and 7.	Contaminated water. Management of wound 1.   Stop bleeding. Apply direct pressure to the wound with a sterile dressing or a clean handkerchief. If necessary press on the arterial pressure- points. 2. Handle the injured part as gently as possible. 3. (Make the patient sit or let him lie down). If the wound is in a limb, and there are not broken bones, raise the limb. This will lessen the bleeding. 4. Wash your hands thoroughly (or clean them with an antiseptic lotion) 5. Remove any foreign objects like glass, stones, etc., if you can easily get at them. This should not open up the wound again which will cause more bleeding. Do not disturb any blood clot already formed. 6. Place a clean dressing over the wound and bandage firmly. 7. Get a doctor. If you cannot get a doctor or nurse, you will have to reach him as early as possible.

Chest Trauma

	 Vital Organs are protected by Ribs and Sternum 	 Critical Injury to the chest can affect Airway, Breathing and Circulation 	 Do not remove Penetrating objects 	 Do not lift off crushing object unless breathing is significantly affected 	Bandage and stabilize them for transportation 	Sucking chest wounds are a special case

Sucking Chest Wounds

Abdominal Wounds

	Should always be evaluated by professionals – call EMS 	Monitor ABCD’s 	Do not give anything to eat or drink 	Treat for Shock 	 If intestines protruding cover with wet, non-adherent dressing and Saran Wrap 	 Watch for Vomiting

Electrical Injuries

DC 	– Usually high voltage 	– Single muscle spasm 	– May throw victim from source 	– May cause heart rhythm disturbances

AC 	– Injury three times greater for same voltage DC 	– Continuous muscle contractions (tetany) 	– Perception of current at 0.2-0.4 mA 	– “Let-go current” is between 6-9 mA 	– Heart arrhythmias between 60-120 mA

	Nerves, muscles, and blood vessels have low resistance and are better electrical conductors than bone, tendon, and fat 	Damage is usually most severe at the source and ground contact points 	Primary injuries are burns 	Skin damage not predictive of deeper damage 	Primary tissue injury may be to deep tissues and evolve over time 	Cardiac rhythm disturbances 	Blood vessel damage and clots 	Fractures and dislocations 	May have associated blunt trauma

Lightning

	Special case of electrical injury 	 Victims may frequently lack both breathing and a pulse 	Treat with CPR

Electrical Injuries

	Treatment: 1. Turn off the power source 2. Make sure the power source is off 3. Do NOT touch the patient until you are SURE the power is off 4. ABC’s 5. Splint fractures and dress wounds 6. All electrocution victims should receive medical attention

Treatment for minor injuries - RICE

	Rest – avoid using 	Immobilization – 20 minutes every 2-3 hours 	Compression with ice – Wrap to keep swelling down especially in joint 	Elevation - Also to reduce swelling

BONE

JOINT

&

MUSCLE

INJURIES The skeleton is a frame work around which the body is built,

In addition, on which all the tissues of the body depend for support.

Muscles attached to the bones work to make them move.

These movements are controlled by the will, and co-

ordinated by specialized nerves.

THE FIRST AIDER SHOULD

	Steady and support the injured part with your hands.

	Find more permanent support for the injured part. Soft tissue

Injuries will benefit from padding and from bandaging, while

Fractures and dislocations may need splinting. An uninjured part

of the casualty’s body provides a natural form of support.

	If a broken bone lies with in large bulk of tissue ( for example, the thigh ) treat the casualty for shock. 	Obtain medical attention. Hospital treatment required for all the most minor injuries.

The body is on a framework off bones. The skeleton – that supports the muscles, blood vessels and nerves of the body, and gives protection to certain organs. Moment is made possible by muscles attached to bones and by movable joints where bones meet.

Bones of the head. The main

Fracture/Dislocation Treatment

	Check ABC’s 	Activate EMS 	Treat for Shock 	Look and feel extremity for CSM 	Circulation – pulses 	Sensation 	Movement 	Stabilize across joint if need to move victim 	  Use RICE until help arrives

Signs and Symptoms of Spinal Injury

	Pain with movement 	Numbness 	Tingling or weakness 	Loss of bowel or bladder control 	Paralysis 	Loss of strength

	Unless the person is able to tell you to the contrary, assume that anyone with a back injury also has a neck injury. Place a board, such as a door or table leaf, next to the person. 	The board should extend below the buttocks (ideally to the feet) and above the head. 	Keeping the head aligned with the rest of the body, gently logroll the person toward you. 	Move the board under the person and ease him or her onto it. If the person is vomiting, lay him or her on one side and continue to support the head.

	Immobilize the person, tie the person to the board with a rope, shirt, belt, or strips of cloth at the ankles, legs, chest, and across the forehead. 	Tie tightly enough so the person cannot move, but not so tightly that you cut off circulation or inhibit breathing.

	Place towels, sweaters, or pillows snugly around the person, especially alongside the head and neck.

	Once immobilized, the person can be carefully moved to safety. Treatment of Spinal Injury

	Seek Immediate medical attention 	 Do Not Move Victim unless absolutely necessary 	 To monitor ABC’s 	 To evacuate from immediate Danger Stabilize before move if possible Monitor ABCD’s until help arrives

EPILEPSY:

	Disease of Young Minor: Pale Eyes fixed & starring Become unconscious for few seconds &resume work. Major: Headache Restlessness. Felling of dullness FIT has four stages: 1.	Sudden loss of consciousness. 2.	Body rigid for few seconds. Face is flushed. 3.	Fit begins in full force. Frothing at mouth & he may bite his tongue. Pass urine/motion. 4.	Attack lasts for few minutes. Convulsion stops. Patient dazed & confused. Act in strange manner with out knowledge what he is doing. After sometime he becomes normal.

First Aid:

1)	Keep the casualty under control. 2)	Do not use force to stop convulsions. 3)	Remove objects that may cause injuries. 4)	Prevent biting of tongue. 5)	Wipe froth from the mouth. 6)	Watch for recurrence after following general rules.

HYSTERICAL ATTACKS:

	Men & Women 	Emotional & Mental stress begins on attacks. 	Signs & Symptoms: 	Loss of control of emotions, rigidity of body & seeming unconscious. 	Convulsions. But these are not typical. 	He may shout or cry, tear his hair, keep the eyes lightly closed. When unconscious he requires audience. 	He falls down deliberately, so that no injury was found. 	Situation is difficult to diagnose. 	First Aid 	Ignore the attack. 	Be firm in dealing in kind. 	After recovery, give him some active work.

FAINTING Causes: 	Decreased blood supply to brain. 	Common. 	Fear of an operation. 	Fright. 	Sad news. 	Rain. 	Sudden fall of Blood Pressure. 	Weak personality. 	Staying long in hot climate. Signs & Symptoms: 	Unconsciousness: 	Sudden 	Giddiness for a second. 	Face pale. 	Pulse: weak, slow. 	Breathing decreased. 	Skin is cold & sticky. First Aid: 	Head down. 	Hold smelling salt. 	Plenty of fresh air. 	Loose the cloth. 	Slightly raise head & make him get up & sit down. 	Give him orange juice, coffee, water.

BITES &STINGS

Animals & Insects do not usually attack unless injured or otherwise provoked, and common sense can prevent many bites & stings. Animal (and Human) bites, always require some degree of Medical attention, because germs are harbored in the mouths of all animals. Snakebites carry the additional risks of poisoning. Even if you have cleaned and dressed a bite wound satisfactorily, you must ensure that the casualty is protected from serious infections as tetanus & rabies. FIRAT AIDER SHOUD: •	Having ensured your own safety, remove the casualty from further danger. •	Treat any visible wound or painful symptoms, and minimize the risk of further injury or infection. •	Obtain medical attention if necessary. •	Note the time and nature of the injury, if possible identifying the attacking creature. This can enable medical personnel to deal with the injury itself and anticipate possible complications, or to establish the “trigger” for a severe allergic reaction. ANIMAL BITES •	Germs are harbored in the mouths of all animals (including humans). •	 Bites from sharp, pointed teeth cause deep puncture wounds that carry germs far into the tissues. •	Human bites also crush the tissues. •	Hitting someone’s teeth with a bare fist can produce a “bite” wound at the knuckles. •	Serious wounds require hospital care; any bite breaking the skin needs prompt first aid, followed by medical attention. TREATMENT:

YOUR AIMS ARE:

1.	To control bleeding. 2.	To minimize the risk of infection, to the casualty and yourself.. 3.	To obtain medical attention.

FOR SUPERFICIAL BITES:

1.	Wash the wound thoroughly with soap & warm water. 2.	Pat dry and cover with an adhesive dressing or a small size dressing. 3.	Advise the casualty to attend Doctor.

FOR SERIOUS WOUNDS:

1.	Control bleeding by applying direct pressure and raising the injured part. 2.	Cover the wound with a sterile dressing, or clean pad bandage in place. 3.	Take or send the casualty to hospital.

RABIES:

This is a potentially fatal viral infection of the nervous system, spread in the saliva of infected animals.

INSECT STINGS:

•	Bee, wasp, and hornet stings are usually more painful and alarming than they are dangerous. •	Mild swelling and soreness, which first aid can relieve, follow an initial sharp pain. •	Some people, however, are allergic to these poisons, and can rapidly develop the serious condition, anaphylactic shock. •	Multiple stings can have cumulative effect. •	Stings in the mouth or throat should be taken very seriously, as the swelling can cause obstructed airway.

TREATMENT:

AIMS OF FIRST AIDER ARE:

1.	To relieve swelling & pain. 2.	To arrange removal to hospital if necessary.

FOR A STING IN THE SKIN: •	Remove the sting, if it is still there with tweezers. •	Apply cold compress to relieve pain and minimize swelling. •	Advice the casualty to attend to Doctor if pain & swelling persists or increases over the next day or two.

FOR A STING IN THE MOUTH

•	Give the casualty ice to suck, to minimize swelling. •	Inform to hospital & call for ambulance. •	Reassure the casualty while waiting for help.

SNAKE BITE: o	More snakes are non poisonous. 	Snakebite is not a serious injury it can be frightening. 	Reassurance is vital, for if the casualty keeps still & calm, the spread of venom may be delayed. 	Keep the snake, or record its appearance, so that, if necessary, the right ant venom can be given.

RECOGNITION: Depending on the species, there may be: •	A pair of puncture marks. •	Sever pain at the site of the bite. •	Redness and marked swelling around the bite. •	Nausea & vomiting. •	Vigorous breathing; in extreme cases, breathing may stop altogether. •	Disturbed vision. •	Increased salivation & sweating.

TREATMENT: Your aims are: 1.	To remove the casualty. 2.	To prevent the spread of venom through the body. 3.	To arrange urgent removal to nearest hospital. •	Lay the casualty down. Tell her to keep calm & still. •	Wash the wound thoroughly with soap & water if available. •	Secure & support the injured part with broad fold bandage above the wound. •	Call for ambulance.

Keep the wounded part below the level of the heart, so that the venom is contained locally. EPILEPSY:

	Disease of Young Minor: Pale Eyes fixed & starring Become unconscious for few seconds &resume work. Major: Headache Restlessness. Felling of dullness FIT has four stages: 5.	Sudden loss of consciousness. 6.	Body rigid for few seconds. Face is flushed. 7.	Fit begins in full force. Frothing at mouth & he may bite his tongue. Pass urine/motion. 8.	Attack lasts for few minutes. Convulsion stops. Patient dazed & confused. Act in strange manner with out knowledge what he is doing. After sometime he becomes normal.

First Aid:

7)	Keep the casualty under control. 8)	Do not use force to stop convulsions. 9)	Remove objects that may cause injuries. 10)	Prevent biting of tongue. 11)	Wipe froth from the mouth. 12)	Watch for recurrence after following general rules.

HYSTERICAL ATTACKS:

	Men & Women 	Emotional & Mental stress begins on attacks. 	Signs & Symptoms: 	Loss of control of emotions, rigidity of body & seeming unconscious. 	Convulsions. But these are not typical. 	He may shout or cry, tear his hair, keep the eyes lightly closed. When unconscious he requires audience. 	He falls down deliberately, so that no injury was found. 	Situation is difficult to diagnose. 	First Aid 	Ignore the attack. 	Be firm in dealing in kind. 	After recovery, give him some active work.

FAINTING Causes: 	Decreased blood supply to brain. 	Common. 	Fear of an operation. 	Fright. 	Sad news. 	Rain. 	Sudden fall of Blood Pressure. 	Weak personality. 	Staying long in hot climate. Signs & Symptoms: 	Unconsciousness: 	Sudden 	Giddiness for a second. 	Face pale. 	Pulse: weak, slow. 	Breathing decreased. 	Skin is cold & sticky. First Aid: 	Head down. 	Hold smelling salt. 	Plenty of fresh air. 	Loose the cloth. 	Slightly raise head & make him get up & sit down. 	Give him orange juice, coffee, water.

IMPORTANT POINTS:

1)	The average man’s lung hold approximately 6 litres of air; a woman’s 4 litres. 2)	In the mouth and upper throat (Pharynx) air shares the same passage as food. As the pharynx divides, a flap (the epiglottis) protects the airway when we swallow, to prevent the inhalation of food or drink. 3)	Larynx is called as “voice box”, lies below the epiglottis. 4)	Adult normally breathes about 16/mt. 5)	Children breathe about 20-30/mt. 6)	Air is mixture of gases, of which 80 per cent is nitrogen and 20 percent is oxygen. 7)	Air we breathe out contains 16 percent oxygen. 8)	Any disturbance of the respiratory process is fatal, since it may lead to asphyxia. It results from any condition that prevents oxygen being taken up by the blood. 9)	The depletion of oxygen in the body is known as hypoxia. In this state the tissues deteriorate rapidly – brain cells start to die if their oxygen supply is interrupted for as little as three minutes.

SYMPTOMS & SIGNS OF LOW BLOOD OXYGEN:

1)	Rapid, distressed breathing and gasping. 2)	Confusion, irritability, and Aggression, leading to unconsciousness. 3)	Usually, blueness of the skin (Cyanosis). 4)	If hypoxia is not swiftly reversed, breathing and the heart may stop.

USING OXYGEN APPARATUS SAFELY:

Always observe the following rules:

1)	Do not smoke or allow any naked flames in the vicinity of oxygen. 2)	Do not use any oils or greases on the control knobs or valves. 3)	Keep equipment in good order. 4)	Make sure the apparatus is checked over and recharged after use.

HEART ATTACK

RECOGNITION:

There may be 	Vice-like chest pain, spreading to left arm. 	Breathlessness. 	Discomfort, like indigestion. 	Sudden faintness. 	A sense of impending doom. 	Ashen skin. 	Blueness at lips. 	A rapid, then weakening, pulse. 	Sudden collapse.

PRECAUTIONS:

	DO NOT give any fluids. 	IF the casualty becomes unconscious, be prepared to resuscitate.

ACTION:

1)	Make casualty comfortable. 	Help the casualty in to a half- sitting position. 	Support his head, shoulders and knee. 	If the casualty has tablets or a puffer aerosol for angina, let him administer it himself. 2)	Call ambulance. 3)	Monitor breathing & Pulse. 4)	Give the casualty aspirin, sorbitrate if present.

SEVERE BLEEDING

PRECAUTIONS:

	DO NOT apply a tourniquet. 	IF there is an embedded object in the wound, apply pressure on either side of the wound, and pad around it before bandaging. 	IF possible wear gloves to protect against infection. 	IF the casualty becomes unconscious, place the casualty in recovery position, and be ready to resuscitate if needed.

ACTION:

1)	Apply pressure to wound. o	Remove or cut the casualty’s clothing to expose wound. o	If a sterile dressing or pad is available, cover the wound. o	Apply direct pressure over the wound with your fingers or palm of your hand. 2)	Raise and support injured part. o	Make sure the injured part is raised above the level of casualty’s heart. o	Lay the casualty down. o	Handle the injured part gently if you suspect the injury involves a fracture. 3)	Bandage wound. o	Apply a sterile dressing over any original pad, and bandage firmly in place. o	Bandage another pad on top if blood seeps through. o	Check the circulation beyond the bandage at intervals, loosen if it needed. 4)	Call ambulance. o	Give details of the site of the injury and the extent of the bleeding when you telephone. 5)	Treat for shock and monitor casualty. o	Treat for shock. o	Monitor and record breathing, pulse, and level of response.

SHOCK

RECOGNITION:

o	A rapid pulse. o	Grey-blue skin, especially on lips. o	Sweating & cold, clammy skin. Later: o	Weakness & giddiness o	Nausea or thirst. o	Rapid, shallow breathing. o	A weak pulse. Eventually: o	Restlessness. o	Gasping for air. o	Unconsciousness. o	Cardiac arrest. PRECAUTIONS:

o	DO NOT leave the casualty alone, except to call an ambulance. o	DO NOT let the casualty eat, move, smoke, or drink.

ACTION:

1.	Lay casualty down. 	Use blanket to protect him from cold. 	Raise and support his legs as high as possible. 	Treat any cause of shock, such as bleeding. 2.	Loosen tight clothing. 	Undo anything that constricts his neck, chest and waist. 3.	Call ambulance. 	Give details of the cause of shock, if known. 4.	Monitor breathing & pulse. 	Monitor and record breathing, pulse, and level of response every 10 minutes. 	Be preparing to resuscitate if necessary.

EYE INJURY

RECOGNITION:

	Intense pain in the affected eye. There may be 	A visible wound. 	A blood shot eye if wound is not visible. 	Partial or total loss of vision. 	Leakage of blood or clear fluid from the injured eye.

PRECAUTIONS:

	DO NOT touch the eye or any contact lens, or allow the casualty to rub the eye. 	IF it will take some time to obtain medical aid, bandage an eye pad in place over the injured eye.

ACTION:

1)	Support casualty’s head. 	Lay casualty on her back, holding her head on your knees to keep it as still as possible. 	Tell the casualty to keep her “good” eye still, as movement of the uninjured eye may damage the injured eye further. 2)	Give eye dressing to casualty. 	Give the casualty a sterile dressing or clean pad, and ask her to hold it over the injured eye and to keep her uninjured eye closed. 3)	Take or send casualty to hospital. 	Call an ambulance if you cannot transport the casualty lying down.

UNCONSCIOUSNESS

PRECAUTIONS:

	DO NOT leave the casualty alone, except to call an ambulance. 	DO NOT give casualty anything by mouth. 	IF the casualty does not regain full consciousness in three minutes phone to ambulance. 	Monitor and record breathing, pulse and response every 10 minutes. 	IF necessary, be prepared to resuscitate.

ACTION:

1)	Assess casualty’s response. 	Gently shake the casualty’s shoulders. 	Question the casualty, speaking loudly and clearly. 	If no response shout for help. 2)	Open airway and check breathing. 	Place two fingers under the casualty’s chin and one hand on her forehead: tilt her head back. 	Check breathing. 3)	Examine and treat casualty. 	Examine the casualty. 	Control bleeding. 	Support suspected fractures. 	Treat any life threatening conditions. 4)	Place casualty in recovery position. 	Monitor and record the casualty’s response every 10 minutes. 5)	Call ambulance.

HEAD INJURY

PRECAUTONS:

	IF possible, wear gloves to protect against infection. 	IF the casualty becomes unconscious, place her in the recovery position, and be ready to resuscitate if necessary. 	IF the casualty is unconscious for three minutes, dial for ambulance. 	IF the bleeding does not stop, reapply pressure on the wound, and add another pad on top of the first.

ACTION:

1)	Control bleeding. 	Replace any displaced skin flaps. 	Place a sterile dressing or clean pad over the wound and apply firm, direct pressure. 2)	Secure dressing with bandage. 	Secure the dressing over the wound with a roller bandage. 3)	Lay casualty down. 	Ensure her head and shoulders are slightly raised. 	Make sure that she is comfortable. 4)	Take or send casualty to hospital. 	Call an ambulance if you cannot transport the casualty lying down.

CONVULSIONS: ADULT

RECOGNITION:

	Unconsciousness. 	Rigidity. 	Breathing may cease. 	Convulsive movements. 	Muscles relax. 	Casualty regains consciousness.

PRECAUTIONS:

	DO NOT use force to restrain the casualty. 	IF the casualty is unconsciousness for more than 10 minutes, is having repeated fits, or it is her first fit. 	Dial for ambulance. 	Note the time and duration of the fit.

ACTION:

1)	Support the casualty. 	Try to ease her fall. 	Talk to her calmly and reassuringly. 2)	Protect casualty. 	Clear away any surrounding objects to prevent injury to the casualty. 	Ask bystanders to keep clear. 3)	Protect the head and loosen tight clothing. 	If possible protect the casualty’s head with soft material until the convulsions cease. 	Undo tight clothing around the casualty’s neck. 4)	Place casualty in recovery position. 	Place the casualty in recovery position. 	Stay until casualty is fully recovered.

CONVULSIONS: CHILD

RECOGNITION:

	Fever. 	Violent muscle twitching. There may be 	Twitching of the face. 	Breathe holding. 	Drooling at the mouth. 	Loss of, or impaired consciousness.

ACTION:

1) Cool child. 	Remove his clothing. 	Ensure good supply of cool air. 2) Protect child from injury. 	Clear away any nearby objects. 	Surround the child with soft padding. 3) Sponge with tepid water. 	Start at his head and work down. 4)	Put child in recovery position. 	Once the convulsions have ceased, put the child in recovery position. 	Keep his head tilted well back. 5)	Call ambulance.

BROKEN BONES

PRECAUTONS:

	DO NOT attempt to bandage if medical assistance is on its way. 	DO NOT attempt to move the injured limb unnecessarily. 	DO NOT allow a casualty with a suspected fracture to have any thing to eat or drink.

ACTION:

1) Steady and support injured part. 	Help the casualty to support the affected part above and below the injury in the most comfortable position.. 2) Protect the injury with padding. 	Place padding, such as towels or cushions, around the affected part, and support it in position. 3) Take or send casualty to hospital. 	Call for an ambulance if you are unable to transport the casualty to hospital.

BACK INJURY

RECOGNITION:

	Pain in neck or back. 	A step or twist in curve of spine. 	Tenderness to touch on spine. There may be 	Loss of control over movement of limbs. 	Loss of, or abnormal, sensation. 	Difficulty in breathing.

PRECAUTIONS:

	DO NOT move the casualty unless she is in danger or she becomes unconscious. . 	IF the casualty becomes unconscious, put her in to recovery position while keeping the head and neck aligned with the spine. Be ready to resuscitate if necessary.

ACTION:

1) Steady & Support head. 	Reassure the casualty and tell her not to move. 	Keep the head, neck, and spine aligned by placing your hands over the casualty’s ears to hold her head still. 2) Support casualty’s neck. 	If you suspect a neck or spinal injury, ask a helper to place rolled towels or other padding around the casualty’s neck and shoulders. 	Keep holding her throughout. 3) Dial for ambulance. 	If possible ask a helper to call an ambulance and to inform the controller that spinal injury is suspected.

BURNS: TREATMENT

PRECAUTIONS:

	DO NOT apply lotions, ointment, or fat to a burn, or touch the injured area or burst any blisters. 	DO NOT remove any thing sticking to the burn. 	IF the burn is to the face, do not cover it. Keep cooling with water until help arrives. 	IF the burn is large or deep, treat the casualty for shock. 	Dial for ambulance. 	Monitor and record breathing, pulse, and level of response for every 10 minutes. 	IF the burn is chemical, rise for at least 20 minutes.

ACTION

1)	Cool burn 	Make the casualty comfortable. 	Pour cold liquid on injury for 10 minutes. 	While cooling the burn, watch for signs of difficulty in breathing. Be ready to resuscitate if necessary. 2)	Remove any constrictions. 	Carefully remove any clothing or jewellery from the affected area before the injury starts to swell. 3)	Cover burn. 	Cover the burn and surrounding area with a sterile dressing, or a clean piece of material. 	Reassure the casualty. 4)	Take or send casualty to hospital. 	Call an ambulance if you cannot transport the casualty to hospital. 	Record details of the casualty’s injuries and any possible hazards.

BURNS: ACTION AND SAFETY

FIRES:

CLOTHING ON FIRE

ELECTRICAL INJURIES:

CHEMICAL SPILLS:

SWALLOWED POISONS

PRECAUTIONS:

	DO NOT attempt to induce vomiting. 	IF there is vomit in the mouth, lay the casualty on his side to allow any vomit to drain away safely. 	IF the casualty stops breathing be prepared to resuscitate. When giving Mouth- To – Mouth ventilation use a face shield to protect your self. 	IF the casualty is conscious and the lips are burned, give the casualty frequent sips of cold water or milk, and seek medical advice immediately..

ACTION

1) Check airway and breathing. 	Check there is no foreign material in the mouth. 	Place two fingers under the casualty’s chin and one hand on his forehead, and tilt the head well back. 	Check the airway and breathing. 2) Place the casualty in recovery position. 	Ensure the airway remains open. 3) Dial for ambulance. 	Give as much information as possible about the swallowed poison. 	Monitor and record breathing, pulse, and level of response for every 10 minutes until help arrive.

ALLERGIC REACTIONS

RECOGNITION:

	Anxiety. 	Red, blotchy skin. 	Swelling of face and neck. 	Puffiness around eyes. 	Impaired breathing. 	Rapid pulse.

PRECAUTIONS:

	Check for EPIPEN or syringe of adrenaline. If necessary, assist the casualty to use it. It can save his life when given promptly. 	IF the casualty becomes unconscious, place him in the recovery position, and be ready to resuscitate, if necessary.

ACTION:

1)Dial for ambulance. 	Pass on as much information about the cause of the allergy as possible. 2) Make casualty comfortable. 	A sitting position should help to relieve any breathing difficulties. 3) Monitor casualty. 	Monitor and record breathing, pulse, and level of response for every 10 minutes until help arrive.

Speedy deletion nomination of User:1966patakota


Hello, and welcome to Wikipedia. A tag has been placed on User:1966patakota requesting that it be speedily deleted from Wikipedia. This has been done under section U5 of the criteria for speedy deletion, because the page appears to consist of writings, information, discussions, and/or activities not closely related to Wikipedia's goals. Please note that Wikipedia is not a free web hosting service. Under the criteria for speedy deletion, such pages may be deleted at any time.

If you think this page should not be deleted for this reason, you may contest the nomination by visiting the page and clicking the button labelled "Contest this speedy deletion". This will give you the opportunity to explain why you believe the page should not be deleted. However, be aware that once a page is tagged for speedy deletion, it may be deleted without delay. Please do not remove the speedy deletion tag from the page yourself, but do not hesitate to add information in line with Wikipedia's policies and guidelines. If the page is deleted, and you wish to retrieve the deleted material for future reference or improvement, then please contact the, or if you have already done so, you can place a request here. P HANTOM T ECH (talk) 22:23, 4 July 2022 (UTC)